Paramedics

A paramedic is a healthcare professional, predominantly in the pre-hospital and out-of-hospital environment, and working mainly as part of emergency medical services (EMS), such as on an ambulance. The scope of practice of a paramedic will vary between countries, but generally includes autonomous decision making around the emergency care of patients. In some countries 'Paramedic' is a protected title and accountable to a professional regulatory body.

The paramedic role is closely related to other healthcare positions, especially the emergency medical technician role, with paramedics often being a higher grade role, with more responsibility and autonomy.

The scope of the role varies widely across the world, having originally developed as a paraprofession in the United States during the 1970s. Since this time, in countries such as the United Kingdom, the paramedic role has developed into an autonomous health profession, with individual licence to practice, whilst in other countries (including the United States) the paramedic remains an agent working on behalf of a doctor. There are different models of care for EMS providers which significantly influence the scope of practice of paramedics in an area. In the Franco-German model paramedics directly support a doctor in the field, in a role more akin to a hospital nurse, rather than operating with clinical autonomy.

The development of the profession has been a gradual move from simply transporting patients to hospital, to more advanced treatments in the field. In some countries, the paramedic may take on the role as part of a system to prevent hospital admission entirely and, through practitioners, are able to prescribe certain medications, or undertaking 'see and refer' visits, where the paramedic directly refers a patient to specialist services without taking them to hospital.

Throughout the evolution of paramedic care, there has been an ongoing association with military conflict. One of the first indications of a formal process for managing injured people dates from the Imperial Legions of Rome, where aging Centurions, no longer able to fight, were given the task of organizing the removal of the wounded from the battlefield and providing some form of care. Such individuals, although not physicians, were probably among the world's earliest surgeons by default, being required to suture wounds and complete amputations. A similar situation existed in the Crusades, with the Knights Hospitaller of the Order of St. John of Jerusalem filling a similar function; this organisation continued, and evolved into what is now known throughout the Commonwealth of Nations as the St. John Ambulance and as the Order of Malta Ambulance Corps in the Republic of Ireland and various other countries.

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